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Dr. Hister on this slient bone disease that is the most common cause of dangerous hip fractures.
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Common Medication Interactions Peoples Pharmacist Ian Lloyd provides advice on the most frequent medication interactions.
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Managing Menopause Osteoporosis If you’re one of those very smart people who pay regular attention to what I have to say (you’re unlike every single member of my family, in other words), you will have surely noticed that in my various contributions to radio, TV, and medical articles in print, especially in this publication, I comment pretty often about that “bone-thinning” condition known as osteoporosis or OP. The reason I do that is very simple: for me, osteoporosis is a very under-recognized – and very preventable - cause of many deaths and a great deal of disability. The way I’ve always tried to make the connection between OP and premature death relevant to you is to consistently remind you guys that among aging folks, like you and me, OP is the most common cause of a fracture of the hip, and sadly, roughly 20 % of women who suffer a hip fracture will die within 6 months of ending up with that fracture (the risk of dying from a hip fracture is even higher in men, by the way, although overall, hip fractures are less common in men, in part because so many of us guys just don’t live long enough to suffer an OP-related fracture). Interestingly, however, that morbid connection of OP to premature death is even worse than that traditional statistic that I just cited because according to a recent study, in women, the risk of dying after a hip fracture stays elevated, not just for those commonly-cited 6 months, but actually stays significantly higher for at least 10 years following the
fracture (the same long-term elevated death risk is probably true in men as well, but alas, osteoporosis in men has simply not been studied nearly as much as it has in women). And if all that is not enough to convince some of the pretty slow learners out there (like, for example, all those idiots who are waiting for a catastrophic injury to occur to an NHL hockey player before adding their voice to the growing public consensus that the NHL better do something about the abominable number of serious head injuries that happen in that league) that they should do all they can, especially earlier in life, to prevent OP, there’s also the matter of the major disabilities that happen to many people as a consequence of a fracture related to OP. Thus, for example, a very large percentage of women (about half) who manage to survive a broken hip will forever be limited by that fracture by never again re-gaining their pre-fracture mobility and independence, meaning that a great many hip fracture victims are forever afterwards confined to a nursing home or to a wheel-chair (or both, of course, in many cases). But wait, there’s still more, because all that doesn’t even address the many fractures of the spine and wrist that end up producing chronic and often hard-to-treat pain and limited movement in so many people who end up with OP. Not a pretty picture, eh, so one would naturally conclude, I suggest, that most people who read Continued On Page 11
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Pharmacist, Peoples Pharmacy
Common Medication Interactions This is what a pharmacist does best; helps to manage your medications and avoid adverse reactions. It is thought that drug interactions are an important cause of hospital emergency room visits. Some drug interactions are known, and sometimes they can even be helpful for your therapy. Others might be detrimental to your health; it is all about context. How can you best protect yourself? The answer is easy: ask your Peoples Pharmacist. Your local Peoples Pharmacist has a list of all of your prescriptions and can determine if any new medications, vitamins, or herbal supplements will conflict. All you have to do is ask. Perhaps the most common drug interaction concern over the counter (OTC) products that contain similar ingredients. This is problematic with cold and flu products for children. It can happen with adult products as well. Let's suppose you choose a multi-symptom cough and cold product. Then you walk across the aisle and pick up something for your headache and fever. Did you know it is likely that both of those products contained acetaminophen? If both products were taken at maximum recommended dosages, there could be enough acetaminophen to harm you. The best way to avoid this problem is to read the labels carefully; look for overlapping ingredients. Or even better, ask your Peoples Drug Mart Pharmacist if combining certain OTC products is safe. Warfarin, warfarin, warfarin, every Pharmacists favourite drug for interactions. The water we drink and the air we breathe can interfere with warfarin. 6 People First peoplesdrugmart.com
This might be an exaggeration, but the drug interaction list for warfarin is quite long. Your physician and Peoples Pharmacist will ensure that your prescriptions will not conflict with warfarin. But what about over the counter products? Be wary of OTC pain killers; some might contain acetylsalicylic acid (ASA), ibuprofen or naproxen. All of these products can interfere with how warfarin works. The same caution applies to the old stomach remedy AlkaSeltzer, it also contains acetylsalicylic acid (ASA). It might be a wise idea to ask your Peoples Pharmacist if any OTC medications will interact with your warfarin before taking them. The same advice applies to vitamin and herbal supplements. Sometimes diet can interact with your warfarin. Foods rich in vitamin % can block warfarins blood thinning action and potentially lead to complications. Foods rich in vitamin % include: broccoli, brussels sprouts, kale, spinach and avocados. This does not mean that you have to fear a bowl of guacamole, just keep things in moderation. If your blood tests have been normal for a while, you can enjoy these foods sporadically. Green, leafy vegetables are good for you. $ust don't go on some radical avocado, dill pickle and watercress diet. This next medication and food interaction is a favourite of Pharmacists. Did you know that grapefruit juice can negatively interact with some prescriptions medications? It is true. It was discovered by accident years ago. Researchers were trying to determine if alcohol could affect the drug felodipine (Plendil, Renedil). The alcoholic drink increased Continued On Page 8
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Ian Lloyd...Continued From Page 6
the amount of felodipine in the blood more than expected. Upon further analysis, they determined it was actually the grapefruit juice, which was used to mask the flavour of the alcohol, that caused the drug increase. How grapefruit juice increased the amount of this drug to enter your body is rather interesting. The lining of your small intestine contains an enzyme that destroys many medications before they enter your body. These enzymes are very useful because they also keep out foreign chemicals and pollutants. A component of grapefruit juice can block this and allow more than expected amounts of medication to enter your body. While at first this might sound advantageous, the results can be dangerous and unpredictable. The effects from a single glass of grapefruit juice can last longer than 24 hours. It is not certain whether whole grapefruits have the same effect, but it might be wise to avoid them also. Which medications can be affected by grapefruit juice? The list is quite extensive and might be a
good question for your Peoples Drug Mart Pharmacist. They have the knowledge and computer software to check for drug interactions. Here is a partial list: amiodarone, some statins (atorvastatin, etc), calcium channel blockers, cyclosporin and Viagra. Lets discuss vitamins, supplements and drug interactions. The list of vitamin and herbal supplement interactions are too long for discussion in this article. However, there is one that appears more often than any other. Calcium, and other minerals, can cause significant drug interactions. The most common interactions occur with certain antibiotics. Another troublesome calcium interaction occurs with medications that help treat osteoporosis, mainly the bisphosphonates. Calcium can bind to these drugs and prevent them from working. While it is important to take calcium if you have osteoporosis, you must be mindful of your other medications. I recommend people do not take their calcium supplements the evening before and the morning of their usual dose of bisphosphonates. Another overlooked common medication interContinued On Page 10
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pharmacist recommended Health & Wellness Information From Your Peoples Pharmacist
The Benefits of Calcium Calcium maintains strong bones and teeth, and helps prevent osteoporosis, which reduces the risk of fractures later in life. Calcium, the most abundant mineral in the body, is found in some foods and is available as a dietary supplement. 99% of the body's calcium supply is stored in the bones and teeth where it supports their structure and function. Bone itself undergoes continuous change, with constant resorption and deposition of calcium into new bone. The balance between bone resorption and deposition changes with age. Bone formation exceeds resorption in periods of growth How Much Calcium Do You Need? Age
Daily calcium requirement
4 to 8 9 to 18 19 to 50 50+ pregnant or lactating women 18+
1000 mg 1300 mg 1000 mg 1200 mg 1000 mg
in children and adolescents, whereas in early and middle adulthood both processes are relatively equal. In aging adults, particularly among postmenopausal women, bone breakdown exceeds formation, resulting in bone loss that increases the risk of osteoporosis over time. If you find it difficult to obtain the recommended amounts of calcium through diet alone, a combination of foods rich in calcium and calcium supplements is a good strategy.
Milk Non Fat 8 Ounces 299mg Calcium per serving Broccoli Raw 1/2 cup 21mg Calcium per serving
health news Exercise May Defend Against Dementia If you need another reason to get into shape: Physical activity may reduce the risk of dementia-related death, according to a recent study. Researchers assessed the health of more than 45,000 men and nearly 15,000 women, ages 20 to 88 years, in the United States, and grouped them into one of three fitness categories -- low, middle or high. After an average follow-up of 17 years, about 4,050 participants died. Of those deaths, 164 were attributed to dementia (72 vascular dementia and 92 Alzheimer's disease). Of those 164 deaths, 123 of the people were in the low-fitness group, 23 were in the middle-fitness group, and 18 were in the high-fitness group. People in the high- and medium-fitness groups had less than half the risk of dying as those in the low-fitness
group, the researchers concluded. The study appears in the journal Medicine & Science in Sports & Exercise. Following the current physical-activity recommendations from the American College of Sports Medicine will keep most individuals out of the low-fit category and may reduce their risk of dying with dementia. While deaths in the United States associated with heart disease, breast cancer and stroke have declined in recent years, deaths related to dementia and Alzheimer's rose 46 percent between 2002 and 2006, according to the release. The study doesn't prove that exercise will prevent dementia, however, other factors may also come into play. peoplesdrugmart.com People First 9
o d...Continued From Page
action occurs in the pain relief aisle. Most people wouldn't think twice about taking an anti-inflammatory tablet for a headache or sore back. The class of drugs called NSAIDS (non-steroidal anti-inflammatory drugs) can raise your blood pressure and affect blood thinning medications. Ibuprofen (Advil, Motrin), ASA (Aspirin) and naproxen (Aleve) are a part of the NSAID group of drugs. They can raise blood pressure by temporarily reducing the effectiveness of the kidneys. For most people this is usually not an issue, but for those with high blood pressure the effects can be worrisome. NSAIDS can also increase the effectiveness of blood thinning medications and cause bleeding complications. It might be best to speak with your physician or Peoples Pharmacist before taking an NSAID. Acetaminophen (Tylenol) would be a safer choice for helping to relieve headaches or other aches and pains. Since we are in the aches and pain aisle, it might be a good idea to take another look at cough and cold medications. The most troublesome ingredient in cough and cold medicines are the oral decongestants. Look for the keywords NstuffyQ or Nrunny noseQ on the packages. People with high blood pressure, diabetes, glaucoma, thyroid disease, an enlarged prostate or taking certain antidepressants should use decongestants with extreme
caution. Or better yet, find another option. Perhaps a non-drug saline nasal spray and a cough suppressant would work just a well. Ask your Peoples Drug Mart Pharmacist if cough and cold medications are right for you. If you are concerned about drug interactions, just ask your Peoples Pharmacist. Don't forget to tell your Peoples Pharmacist about any other supplements you might be taking; that information can be very useful. They can determine which medicines are right for you and which may be detrimental. If you are curious about possible drug/herbal/food interactions, look them up yourself. The website www.drugs.com has a free and robust drug interaction checker. $ust take this information with a grain of salt - unless you are on a sodium reduced diet. Medical websites are great and can provide you with ample information to make health choices. However what they are not able to tell you is whether this information is applicable to you. Your Peoples Pharmacist can add context to the information you have found - all you have to do is ask. Written By Ian Lloyd, Pharmacist & Chartered Herbalist, Peoples Pharmacy
Don’t Play A Guessing Game With Your Daily Medications Many people today are on more than one medication and when you combine this with a busy and active life, it can lead to the confusion of properly taking your medications. Medication non-compliance is a major concern and accounts for approximately 25% of all hospital admissions among seniors. Peoples Drug Mart and Peoples Pharmacy offer a medication compliance program called “Med Manager.” The Med Manager is a medication compliance card that conveniently organizes your medications for a full week, and helps you easily identify what medications are to be taken at what time of the day. Talk to your Peoples Pharmacist about the Med Manager program.
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Dr. Hister...Continued From Page 4
some of this stuff would then immediately determine to do all they can to prevent OP and a subsequent fracture, although sadly, studies tell us pretty clearly that most people deal with OP only in the same manner that they deal with most things they don’t want to think about, that is, they fall back on the age-old custom of ignoring the problem until it’s finally unavoidable to confront, which for most people, alas, is when they suffer their first fracture. So how do you prevent OP? Well, to start, it’s important to realize that there are some risk factors you can do nothing about (it really is too late, for example, to trade in your family for one in which OP does not run genetically) but among the major OP risk factors that you can control, these stand out for me: • don’t smoke • do lots of weight-bearing exercise such as walking or jogging (hopefully starting as soon as you’ve finished reading this article, and maybe even while you’re reading it) but not, please note, swimming or cycling (which are not weight-bearing exercises) • don’t drink too much alcohol • eat a good diet with lots of calcium-rich foods (especially dairy products, if you can stomach them) • don’t forget to also include regular healthy doses of vitamin D-rich foods (fish, for example) • make sure to get enough sunshine exposure to keep your vitamin D levels up, especially during the summer, and (one other major risk factor that is often over-looked) • be as cautious as you can about the overuse, especially long-term, of certain drugs that have been related to a higher risk of hip fracture, particularly those drugs used for gastric acid reflux known as proton pump inhibitors or PPIs (Losec, Nexium, Pariet, Prevacid, et al), which is as good a time as any to offer my regular reminder that if you’re not completely sure what side effects or drug interactions your particular medications can produce, take your questions and
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Dr. Hister...Continued on Page 13
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Are your medications working effectively for you? Medication Review Service The Peoples Drug Mart medication review service was created to ensure medication therapy is appropriate and effective for those taking multiple medications. Your Peoples Pharmacist will ensure all your medications are compatible with each other and working optimally. Medication review includes • Detailed analysis of all medications (prescription and over-the-counter), vitamins and supplements, to ensure safe and effective use • In-depth consultation to improve health outcomes by helping resolve any issues that have arisen due to your medications A Peoples Drug Mart medication review provides an opportunity for you to sit down one-on-one with your Peoples Pharmacist to help identify and resolve common medication-related issues, so you can get the most benefit from your medication. This medication review can help you better understand your medication therapy, and ensure that medications are being taken as prescribed. Speak to a Peoples Pharmacist about scheduling a free medication review.
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Dr. Hister...Continued From Page 11
concerns to your Peoples Pharmacist, a terrific source of knowledge about all important pharmaceutical information. The final important OP-related issue that I want to address in this article (again, mostly because of some recent news that will affect a great many of you) is how to screen for OP, that is, which tests to do and how often to do them. People at high-risk for OP (for example, those with a significant family history of this condition or small, thin women or middle-aged women who’ve already suffered a fracture or people who have been taking cortisone treatment for a long time, and a whole lot of others) need to get a first screening bone scan pretty early in life – probably around the age of 50. The rest of us, however, that is, those of us at average-risk for OP, can wait till the age of 65 to get our first screening bone scan, and the news here is that a recent study found that a woman with a normal bone scan at the age of 65 can safely wait at least another 15 years before having to undergo yet another scan, which is good news for both those of us who hate being tested too much, as well as for those who are running our medical system because if this practice is widely adopted, as I’m sure it will be soon, it will cut down on hundreds of thousands of seemingly needless repeat bone scans. Finally, a word of advice that brings me back to something I sort of alluded to at the top: if you want to stay well, you really should pay attention to health news, and if I may humbly say this, a great way to do that is to stay current with what I discuss in various media outlets, and to remind you to do that on a regular basis. I offer you a neat little ditty that you should hum every morning over your healthy breakfast of muesli and a double cappuccino (with apologies to Mel Brooks): Don’t be stupid, be a smarty, time to hear again from Artie. You’re welcome. Dr. Art Hister can be heard on CKNW and other Corus Radio Network stations on House Calls on Saturdays at 10 AM, as well as seen on Global TV news on Saturday mornings at 9:20.
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Brain Matters For most people, the realization of an approaching midpoint in life usually happens somewhere between age 40 and 50; it can be the result of a major wake up call or just an awareness that NthingsQ just are not working quite like they used to. A good example here is our brain; few of us reach the middle age milestone without experiencing the daily frustration that accompanies the ability to remember names, phone numbers and the actual point of the story we so enthusiastically began telling. Of course this leads to fear around the onset of early dementia, Alzheimer’s and Ngeneral scatterbrained syndrome;Q the latter being my personal catch phrase for my own brain lapses when menopause began knocking on my door. Cognitive decline is a valid concern for many of us who want to age gracefully and a recent study published in the British Medical $ournal suggests that our brains do begin to lose their sharp edge after the age of 45. But not to worry, the study may say that 45 is a turning point, but there is still much we can do to keep our grey matter in optimal shape. What was I thinking? Three years ago, after a very long lapse from academia and in the middle of the menopausal transition, I made a decision to go back to school and begin the journey toward a Bachelor of Social Work. The first year was the hardest as I had to relearn how to learn and I found that memorization took more effort than it used to in my younger days. But developing good study habits has paid off; I am now in the final months of my third year and can boast achieving honours standing and can actually feel the neurons firing along their new pathways. It is probably a good thing that my brain was under functioning when I applied to the program because had I full capacity to actually think this decision through I may not have discovered how amazing the human brain actually is Use it or lose it The brain is like a muscle, and it does rise to the challenge of a good workout. We come into this world hard wired to learn. The brain still has the ability to lay down new pathways for knowledge in old age, it also has a built in mechanism to prune out pathways that are no longer
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travelled. While serious cognitive impairment may be a result of disease, illness or accident, much age related cognitive decline is due to a lack of mental stimulation. Understandably, not everyone will want to choose the path of higher education for stimulation; try incorporating some of these easy and fun ways to get a good brain workout into your daily routine: 1. Switch it up. Remember how hard you had to concentrate when you were learning how to tie your shoelaces? Try other activities like brushing your hair or teeth with your nondominant hand; over time, the neural pathways will become stronger and it will not seem as awkward anymore. 2. Turn off the TV and engage the brain in an interesting book, game, new hobby or craft. Word puzzles and number puzzles top the list of brain exercises and the local newspaper and the Internet are both good sources to find similar brain challenges. 3. Take a class and try something new and completely different. It doesn’t matter if you choose to learn a new musical instrument, explore yoga, ballroom dancing or oil painting - the important thing is that the brain has to learn new body mind connections. 4. Move your body. Even gentle exercise increases circulation and ensures the brain is getting plenty of oxygen and glucose. Be sure to drink your water and eat a healthy diet as well. Studies have correlated regular daily exercise to a lower risk of developing cognitive decline including dementia and Alzheimer’s. 5. Strengthen your memory by playing games that test it. You can also practice memorizing grocery lists, word lists and new phone numbers. Remember too that we are social creatures; maintaining friendships and being present with our loved ones stimulates the brain as we engage in conversation and exchange of ideas. The loneliness factor is also eliminated which contributes to a brighter outlook and overall sense of wellness. Personally I will take a page out of Gandhi’s book. NLive as if you were to die tomorrow. Learn as if you were to live forever.Q Good Health to You
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PEOPLES DRUG MART & PEOPLES PHARMACY LOCATIONS LOWER MAINLAND
VANCOUVER • 7160 Kerr St. 434-2656 • 571 West 57th Ave 324-2258 BURNABY • 4218 Dawson St. 299-6677 NEW WESTMINSTER • 825 McBride Avenue 525-2474 PORT COQUITLAM • 2529 Shaughnessy 941-2413 COQUITLAM • 137-3030 Lincoln Ave. 464-1033 • 1001 Austin Ave. 936-0024 ABBOTSFORD • 1945 McCallum Rd. 859-2351 SURREY • #177- 8138 – 128th St. 598-3233 • 10212 - 152nd St. 580-7457
LOWER MAINLAND WHITE ROCK • 1463 Johnston Rd 531-4636
GOLD RIVER • 375 Nimpkish Drive 283-9042 UCLUELET • 1892 Peninsula Road VICTORIA 726-2733 • 3825 Cadboro Bay Rd. COURTENAY 477-2131 • 102-1350 England • 15-1594 Fairfield 334-9311 598-9232 CAMPBELL RIVER • 1282 Fairfield Rd. • #101-2276 S.IslandHwy. 595-5997 923-7311 • 2642 Quadra St. • #984 Shoppers Row 383-1188 287-8311 • 3643 Shelbourne St. QUADRA ISLAND 477-1881 • 5-654 Harper Road • #102-2020 RichmondRd. 285-2275 370-1166 PORT McNEILL • 1584 Broughton St. VANCOUVER ISLAND 956-3126 • SOOKE PORT HARDY 8-6716 Sooke Rd. • 100-8950 Granville St. 642-2226 949-9522
THOMPSON OKANAGAN KOOTENAYS
ASHCROFT • 403 Railway Ave. E. 453-2553 CHASE THOMPSON OKANAGAN • 825 Shuswap Ave. 679-3553 KAMLOOPS • 103-275 Lansdowne St. SCOTCH CREEK • 3874 Squilax Anglemont 374-3112 955-0601 KELOWNA • 1715 Ellis St. KOOTENAYS 712-2484 • #104 – 330 Hwy. 33 REVELSTOKE • 555 Victoria Rd 491-1999 837-5191 • 200-3591 Elliot Rd. GOLDEN 768-7645 • 1104 -10th Ave S. PENTICTON 344-6821 • 166-1848 Main St. TRAIL 493-7200 • 1101 Dewdney Ave. LYTTON 364-1993 • 531 Main Street ROSSLAND 455-6685 • 2060 Columbia Ave. 362-5622 MACKENZIE • 700 Mackenzie 997-5460
SALMO • 107 - 4th St. 357-9444 NELSON • 405 Hendryx St. 352-3121 SPARWOOD • 107 Centennial Square 425-2015 NAKUSP • 88 Broadway St. 265-2228 CRANBROOK • East Kootenay Hospital 13 -24th Ave. North 420-4133
PEACE RIVER CHETWYND • 4733 - 51 Street 788-3393 st
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*Points awarded on net pre-tax purchases. Certain restrictions apply (check with your local Peoples Drug Mart or Peoples Pharmacy for a complete list of non-eligible medications, services & products). Some stores may use a manual system with a different reward level.
The articles published in People First are for the general information of the reader. While effort is made to reflect accepted medical practice and knowledge, articles should not be relied upon for the treatment or management of any specific medical concern or problem and People First accepts no liability for reliance on the articles. For proper diagnosis and medical care, you should always consult your family physician promptly. Opinions expressed in sponsored articles by, Dr. Art Hister, Ian Lloyd, and Darlene Booth are paid editorials and are not necessarily shared by Peoples Drug Mart stores or Peoples Drug Mart (B.C.) Ltd. Some advertised products are not available in all stores. We reserve the right to substitute products or limit quantities. Prices effective while quantities last. Sale in retail quantities only.
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Published on Mar 27, 2012
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